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Caustic ingestion

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of caustic ingestion are prepared by our editorial team based on guidelines from the American Society for Gastrointestinal Endoscopy (ASGE 2021) and the World Society of Emergency Surgery (WSES 2019).
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Diagnostic investigations

History taking: as per WSES 2019 guidelines, determine the nature, the physical form, and the quantity of the ingested agent as well as the accidental-voluntary ingestion pattern for emergency management of corrosive injuries.
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More topics in this section

  • Contacting Poison Control Centers

  • Laboratory studies

  • Imaging

Diagnostic procedures

Upper gastrointestinal endoscopy: as per WSES 2019 guidelines, perform emergency endoscopy if CT:
is unavailable
with contrast administration is contraindicated (renal failure, iodine allergy)
suggests transmural esophageal necrosis but interpretation is difficult or uncertain.
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Nonpharmacologic interventions

Indications for non-surgical management
As per WSES 2019 guidelines:
Offer non-surgical management for patients who do not have full-thickness necrosis of digestive organs.
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Repeat CT and consider for surgery if any deterioration in the condition of the patient is reported.
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Therapeutic procedures

Endoscopic dilation: as per WSES 2019 guidelines, attempt endoscopic dilation 3-6 weeks after ingestion in patients with few (< 3) short (< 5 cm) esophageal strictures.
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Surgical interventions

Surgery: as per WSES 2019 guidelines, consider reconstructive esophageal surgery after recurrent failure of endoscopic dilation.
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Specific circumstances

Patients with gastric outlet obstruction: as per ASGE 2021 guidelines, insufficient evidence to uniformly support either endoscopic or surgical management in patients with mixed varieties of benign gastric outlet obstruction. Take into account the etiology of benign gastric outlet obstruction, length of stricture, and response to initial endoscopic balloon dilation in determining appropriate management.
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Follow-up and surveillance

Psychiatric evaluation: as per WSES 2019 guidelines, obtain psychiatric evaluation in all patients before hospital discharge.
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